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E,~.,_~L1-8-?2 _ <br /> <br />Septic.tank= Minimum liquid ¢ol~c~t~,~,,,¢h distribution box <br /> <br />Lot survey , ..... <br />OJher requirements- <br /> <br /> ..... ~. - ..... , <br /> <br /> RecOrd Of Individual Sewage Disposal System <br />TO Be Completed by Installer ~ <br /> <br /> W~,ter s!Jpply Publi~ syste~ .... Individ¢~ well ~ ~ Community system ........ <br /> Total Ilqu,d copac,ly /~ gal. Inside length ~ -- fl. inside width <br /> Diameter , ~ft, L~uid depth .~/ ft. <br /> <br />To~l length of oil lines~ - ,~ ~ ~,fl, Distance <br /> <br />Total ~uore footoge~.. , . fL Nearest <br />Distance baleen lines fi, LoT line; Front ~ Side ~ Rear ~ ft. <br /> Foundation ..... ff <br />,~,. o, ,,,,.~ ~,~,~,~ ~.~.,- ~ ~ ~ S,~, ..... ~':i~ ~'"'"~ ','% ~ - <br /> <br /> NOte, Indicate Northrl~ly ¢~,e~~ ~ <br /> Inspechon will not be ~a~ until <br /> <br />SyllOm apparent~ will ~ will hal ~ <br /> <br />completed form ~r'~turned to the Health. 0epf. <br /> <br /> <FOR HEA, LYH DEPT_ <br />function sotisfoctorily, o~d ;s therefore approved ~ Disapproved ~ <br /> <br />~ote_/= ,Z - 7 2--- <br />Copies: (1) O~-i9, HO File'. <br /> <br /> <br />